DONATION RESPONSE FORM - Single Parent Resource Centre

Practical support, empowerment, hope.
OPTION ONE: Single Contribution.
My gift of:
$500 will provide practical support for 6 families for one year
$250 will provide emergency food hampers for 10 families
$100 will purchase 4 emergency food cards for single parent families
$50 will purchase a child’s elementary school supplies
other amount or purpose, please specify: $_______________________________________
Use the credit card payment method below, or enclose a cheque payable to 1Up Single Parent Resource Centre.
OPTION TWO: Monthly Contribution
I want to make a difference by joining the MONTHLY GIVING CLUB by pre-authorized debit, using my
chequing account (please include VOID cheque).
Once per month I will gift:  $10
 $25  $89 (supports 15 families/year)
 other $________
Please charge my credit card:  Visa
 MasterCard
Card number ____________________________________________ Expiration Date _____|_____|_____
Authorized Card Signature ________________________________________
 Please use the following name(s) in all acknowledgements:
Name 1 ________________________________
Name 2 __________________________________
 I (we) wish to remain ANONYMOUS
 I (we) would like information on making a planned gift.
Today’s Date:_____________________
Name: ______________________________________ Signature_________________________________
Address________________________________________ City______________ Postal Code____________
Telephone_______________________ Email________________________________________________
MAIL to: 1Up, 602 Gorge Road East, Victoria BC V8T 2W6, or FAX to: 250-361-3554,
or PHONE Trevor at 250-385-1114 or GIVE ONLINE via
Thank you for your kind and generous support.
Donations of $20 and higher will automatically receive a charitable tax receipt. Charitable tax #10798 2472 RR0001.